| NPI | 1932683323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY P128122) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NY 34794) |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: NY P128122) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: NY P128122) | |
| Enumeration Date | 2018-09-20 |
| Last Update Date | 2024-06-26 |